The Child Measurement Programme for Wales 2016/17

2 The Child Measurement Programme for Wales 2016/17

Production team

Linda Bailey – Consultant in Public Health / Health Intelligence

Ciarán Humphreys – Director of Health Intelligence

Leon May – Senior Public Health Intelligence Analyst

Rhys Powell – Senior Public Health Intelligence Analyst

Hugo Cosh – Principal Public Health Intelligence Analyst

Zoe Strawbridge – Public Health Intelligence Analyst

James Allen – Public Health Intelligence Analyst

Lloyd Evans – Advanced Public Health Intelligence Analyst

Megan Luker – Public Health Information Officer

Lance Webster – Ridler Webster Ltd

Rhian Huws – Canna Translation

Data extraction

Gareth John (NHS Wales Informatics Service)

Acknowledgements

Many thanks to the families and children who participated in the programme and to all the staff in Health Boards who have supported the programme across Wales.

Publication detailsTitle: Child Measurement Programme for Wales 2016/17

Publisher: Public Health Wales NHS Trust

Date: 19th April 2018

ISBN 978-1-910768-46-4

For further information please contact: childmeasurementprogramme @wales.nhs.uk

Website: www.publichealthwales.org/childmeasurement

© 2018 Public Health Wales NHS Trust.

Material contained in this document may be reproduced under the terms of the Open Government Licence (OGL)

www.nationalarchives.gov.uk/doc/open-government-licence/version/3/ provided it is done so accurately and is not used in a misleading context.

Acknowledgement to Public Health Wales NHS Trust to be stated. Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust.

The Child Measurement Programme for Wales 2016/17 3

ContentsCharts, tables and maps 4

Introduction 5

Summary 5

Results 6

Healthy weight 6

Healthy weight or underweight 6

Obesity 7

Deprivation 8

Ethnicity 9

Urban / rural analysis 10

Comparison 11

Participation 12

Abbreviations 13

4 The Child Measurement Programme for Wales 2016/17

Charts, tables and maps Page

Figure 1 – Percentage of children aged 4 to 5 years who are underweight, healthy weight, overweight or obese 2012/13 – 2016/17 in Wales 5

Figure 2 – Percentage of children aged 4 to 5 who are obese, health boards and local authorities, 2016/17 7

Figure 3 – Percentage of children aged 4 to 5 years who are obese, most and least deprived fifth in Wales, 2016/17 9

Figure 4 – Percentage of children aged 4 to 5 years who are obese by ethnic group 2012/13 - 2016/17 10

Figure 5 – Percentage of children aged 4 to 5 years who are overweight or obese, rural and urban areas in Wales 2016/17 10

Figure 6 – Percentage of children aged 4 to 5 years who are overweight or obese, Wales, England and the English regions, Child Measurement Programme for Wales and the National Child Measurement Programme (England) 2016/17 11

Table 1 – Participation in the Child Measurement Programme for Wales since 2012/13 12

The Child Measurement Programme for Wales 2016/17 5

Introduction

This report contains key findings of the Child Measurement Programme for Wales (CMP). The full analysis, including data tables, graphs and maps are presented on the Child Measurement Programme website at: www.publichealthwales.org/childmeasurement

Information about the history of the programme and how information is collected and analysed is also available on the website. The downloadable document “The Child Measurement Programme for Wales: history, legislative framework and technical aspects” gives information on measurement of body mass index, prevalence categories used in Wales and how statistical significance is assessed.

This is the 6th year the programme has run, however the first year’s results are no longer included in analysis and discussion, as not all the CMP standards

and guidance were in place when the first year measurements were taken. The programme in Wales relates to measurements of children aged 4 to 5, who are both attending reception class in Wales, and have a residential postcode in Wales.

Summary

The summary results of the programme are shown in Figure 1.

As the programme has been running for six years, it may be possible now to detect trends. Obesity prevalence is statistically significantly higher in 2016/17 than in either of the previous two years. However the difference in obesity prevalence between 2016/17 and 2013/14 is not statistically significant, so no overall trend for the period can be confirmed. There is no statistically significant difference across the years in prevalence of healthy weight or overweight.

Figure 1 – Percentage of children aged 4 to 5 years who are underweight, healthy weight, overweight or obese 2012/13 – 2016/17 in Wales.

Produced by Public Health Wales Observatory using CMP data (NWIS)

73.272.772.972.972.2

14.914.614.514.514.7

11.311.811.611.712.4

0.60.80.91.00.8

12/13Underweight Healthy weight Overweight Obese

13/1414/1515/1616/17

6 The Child Measurement Programme for Wales 2016/17

ResultsHealthy weight

72.2% of children measured in Wales are of a healthy weight. The prevalence of healthy weight in girls (72.5%) is higher than in boys (71.9%) but the difference is not statistically significant at national level, nor it is significant at any local level.

Healthy weight or underweight

A very small percentage (0.8%) of children in Wales are categorised as underweight. Because of the risk of identification of individuals where small numbers are involved, the categories of underweight and healthy weight

are combined for some of the health boards and local authorities. At national level, 72.9% of children were either a healthy weight or underweight, There is significant variation at a more local level – 83% of children in the Vale of Glamorgan were in this category, while only 67.3% of children measured in Merthyr Tydfil were categorised as healthy weight or underweight.

The Child Measurement Programme for Wales 2016/17 7

Obesity

In 2016/17 obesity prevalence in this age group is higher than the Welsh average of 12.4% in two local authorities: Merthyr Tydfil (17.5%) and Blaenau Gwent (15.1%), and the difference is statistically significant. Cardiff (10.7%), the Vale of Glamorgan (7.8%) and Monmouthshire (8.0%) are three local authority areas where obesity prevalence

is statistically significantly lower than the Welsh average. Information on obesity prevalence at a lower level than local authority is available on the Child Measurement Programme website, where it is mapped at Middle Super Output Area (MSOA) level. The average population per MSOA is 7,000 people of all ages.

Figure 2 – Percentage of children aged 4 to 5 who are obese, health boards and local authorities, 2016/17

Produced by Public Health Wales Observatory using CMP data (NWIS)

12.711.313.313.110.0

Betsi Cadwaladr UHB

95% confidence interval Wales = 12.4

Powys THBHywel Dda UHB

ABM UHBCardiff and Vale UHB

14.4Cwm Taf UHB11.8Aneurin Bevan UHB

14.213.014.412.110.9

Isle of AngleseyGwynedd

ConwyDenbighshire

Flintshire12.8Wrexham10.9Ceredigion13.414.013.511.813.5

PembrokeshireCarmarthenshire

SwanseaNeath Port Talbot

Bridgend7.8Vale of Glamorgan10.7Cardiff13.617.513.615.111.4

Rhondda Cynon TafMerthyr Tydfyl

CaerphillyBlaenau Gwent

Torfaen8.0Monmouthshire10.8Newport

8 The Child Measurement Programme for Wales 2016/17

However when obesity prevalence is aggregated for the last five years – 2012/13 to 2016/17, obesity prevalence is statistically significantly higher than the Welsh average of 11.8% (combined for the same years) in seven local authorities:-

● Gwynedd – 12.9%

● Pembrokeshire – 12.8%

● Carmarthenshire – 12.8%

● Rhondda Cynon Taf – 13.3%

● Merthyr Tydfil – 16.6%

● Caerphilly – 12.8%

● Blaenau Gwent – 13.9%

Deprivation

Every year the child measurements are analysed by deprivation. There are 1,909 Lower Super Output Areas (LSOA) in Wales, with a deprivation rank assigned to each LSOA. These scores are then assigned to quintiles (fifths). The children’s postcode of residence are assigned to an LSOA. The gap between obesity prevalence in the most and least deprived quintiles is shown in Figure 3. This year the gap between obesity prevalence in the most and least deprived quintiles has increased from 4.7% last year to 6.2% this year. 14.9% of children living in the most deprived quintile are obese, and this is statistically significantly higher than obesity prevalence in any of the other four quintiles.

However it is important to remember that not all individuals living in an area classified as deprived, are themselves living in deprived circumstances. Deprivation is more concentrated in some areas of Wales such as Merthyr Tydfil, but there are pockets throughout the country. In Monmouthshire there are no LSOA areas ranked within the most deprived quintile.

The Child Measurement Programme for Wales 2016/17 9

Figure 3 – Percentage of children aged 4 to 5 years who are obese, most and least deprived fifth in Wales, 2016/17

Produced by Public Health Wales Observatory using CMP data (NWIS) and WIMD 2014 (WG)

When obesity prevalence amongst children living in the most deprived quintile is aggregated for the five years between 2012/13 and 2016/17, the pattern persists, with 13.7% of children categorised as obese in the most deprived quintile, and 8.7% in the least deprived quintile. Again, the 13.7% figure for the most deprived quintile is statistically significantly higher than any of the other four quintiles.

Ethnicity

The number of children of an ethnic origin other than white is small in Wales. This year only 0.6% of children

measured had their ethnicity recorded as black. Nearly 80% have their ethnicity recorded as white, while for 15% of the children, ethnicity is recorded as not known. Therefore when the analysis of child measurements by ethnicity is undertaken, it may be best to combine the measurements over a number of years, to provide more robust results. This is displayed in Figure 4, and as can be seen, there is significantly higher prevalence of obesity in children whose ethnicity is recorded as black than in children whose ethnicity is recorded as white or not known.

13.2

8.1

2012/13 2013/14 2014/15 2015/16 2016/17

5.1

13.5

9.4

4.1

13.2

8.6

4.6

13.5

8.8

4.7

Difference between most and least deprivedMost deprived

14.9

8.7

6.2

Least deprived

10 The Child Measurement Programme for Wales 2016/17

Figure 4 – Percentage of children aged 4 to 5 years who are obese by ethnic group 2012/13 - 2016/17

Produced by Public Health Wales Observatory using CMP data (NWIS)

Urban / rural analysis

Three years ago, child measurements were analysed according to whether children were living in urban, rural or very rural areas of the country. At that time it was observed that there was very little difference between prevalence of the weight categories. The analysis was repeated this year, looking across two

categories, urban and rural. Again very little difference was observed (Figure 5). While prevalence of overweight and obesity combined appears slightly higher in rural areas, prevalence of obesity alone appears slightly higher in urban areas. However the differences in both categories are not statistically significant.

Figure 5 – Percentage of children aged 4 to 5 years who are overweight or obese, rural and urban areas in Wales 2016/17

Produced by Public Health Wales Observatory using CMP data (NWIS)

12.012.415.511.813.1

White

95% confidence interval Wales = 11.8

AsianBlackMixed

Chinese or other10.2Not known

26.926.2

2012/13 - 2016/17 2016/17

0.7

27.426.9

0.5

Difference between Rural and Urban areasRural Urban

The Child Measurement Programme for Wales 2016/17 11

Comparison

England also has a national child measurement programme (the NCMP), where all children are weighed and measured in reception year. The same growth reference scale (UK90) is used in both England and Wales, so it is possible to draw robust comparisons between

the two countries. Figure 6 shows that prevalence of overweight and obesity is significantly higher in Wales than in England or in any of the English regions. The same is true of obesity prevalence, which at 12.4% in Wales, is statistically significantly higher than the 9.6% figure for England.

Figure 6 – Percentage of children aged 4 to 5 years who are overweight or obese, Wales, England and the English regions, Child Measurement Programme for Wales and the National Child Measurement Programme (England) 2016/17

Produced by Public Health Wales Observatory using CMP data (NWIS) and NCMP data (HSCIC)

24.5

23.9

22.2

22.8

24.1

North East

95% confidence interval

North WestYorkshire and the Humber

East MidlandsWest Midlands

21East of England

22.3London

21.4

23.1

South EastSouth West

22.6England

27.1Wales

12 The Child Measurement Programme for Wales 2016/17

Participation94.1% of children in Wales who were eligible to participate in the programme were measured and their measurements included in the analysis. This is a slight increase on participation last year. 94.6% of girls and 93.7% of boys participated. There is very little variation in participation rates by deprivation quintile.

The Health Board with the highest participation rate was Betsi Cadwaladr University Health Board (UHB) with a participation rate of 96.6%, while the health board with the lowest participation was Powys Teaching Health Board (THB) with a participation rate of 89.2%. Because of the rurality of Powys and distances involved, school health staff may not be able to visit a school a second time to carry out ‘catch-up’ measurements. By local authority, Wrexham had the highest participation rate at 98.6%, and Merthyr Tydfil had the lowest at 84.0%

Each year a census is taken of all the schools in Wales. In 2016/17, 35,592 children were recorded as attending reception class. There is a small difference (295) between the census figures and the CMP eligibility figures, which might be explained by inclusion of children resident in England but attending schools in Wales in the census; movements in and out of schools; or the timing of the census which is taken on one day in January, while the child measurements are carried out throughout the school year. However when the number included in the measurement programme is compared to the number of children counted in the school census, it appears that coverage of the CMP is very good. 129 children were opted out of the programme by their parents

Table 1 – Participation in the Child Measurement Programme for Wales since 2012/13

Elligible Measured % Participation

2012/13 34,679 29,238 84.3%

2013/14 33,794 30,669 90.8%

2014/15 34,815 32,889 94.5%

2015/16 35,721 33,327 93.3%

2016/17 35,297 33,226 94.1%

Produced by Public Health Wales Observatory using CMP data (NWIS)

The Child Measurement Programme for Wales 2016/17 13

More informationThis report provides a brief summary of the analysis of the child measurements taken for the Child Measurement Programme. More comprehensive information displayed as charts, tables and maps, can be found on our website at www.publichealthwales.org/childmeasurement

For more information about tackling childhood obesity please go to the Public Health Wales Health Improvement website at: www.everychildwales.co.uk and follow the link to the “10 steps to a healthy weight” information.

Abbreviations

BME Black and minority ethnic

BMI Body mass index

CMP Child Measurement Programme for Wales

LSOA Lower super output area

MSOA Middle Super output area

NCCHD National Community Child Health Database

NCMP National Child Measurement Programme (England)

NHS National Health Service

NWIS NHS Wales Informatics Service

THB Teaching Health Board

UHB University Health Board

UK90 Growth reference system used in the CMP

WHO World Health Organisation

WIMD Welsh index of multiple deprivation

The Child Measurement Programme for Wales 2016/17

www.publichealthwales.org/childmeasurement